Provider Demographics
NPI:1356519995
Name:WILLIAMS, WHITNEY ALISON (ST)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:ALISON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 BURTON RD
Mailing Address - Street 2:
Mailing Address - City:BARNEY
Mailing Address - State:GA
Mailing Address - Zip Code:31625-1616
Mailing Address - Country:US
Mailing Address - Phone:229-775-2386
Mailing Address - Fax:229-890-3397
Practice Address - Street 1:300 SUNSET CIR
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6934
Practice Address - Country:US
Practice Address - Phone:229-985-2080
Practice Address - Fax:229-890-3397
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001304235Z00000X
GASLP007008235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPCET001304OtherBD FOR S.T.
GASLP007008OtherSTATE LICENSE NUMBER